Experimental validation of a pinless femoral reference array for computer‐assisted hip arthroplasty

The use of computer navigation systems during total hip arthroplasty requires the femoral fixation of a reflective dynamic reference base (DRB), which theoretically involves the risk of bony fracture, infection, and pin loosening. The first objective of this study was to evaluate the relative movements between a novel, noninvasive external femoral DRB system and the femur. Secondly, the maximum effects of these 3D movements on intraoperative, computer‐assisted leg length and offset measures were evaluated. An imageless navigation system was used to track the positions of the soft tissue attached, pinless DRB relative to an invasive reference marker on the femur during a less‐invasive, anterior surgical hip approach. Relative translatory movements up to 8.2 mm mediolaterally and up to 8.8° in rotation were measured. Using a measurement technique in which the calculation of leg length and offset changes is primarily based on a specific realignment of the leg, maximum differences of 1.3 mm for leg length and 1.2 mm for offset were found when comparing the pin‐based and pinless methods. Thus, invasive fixation techniques with screws or pins are still the method of choice when standard measurement algorithms for intraoperative leg length and offset measures are used. Though direct translatory and rotational variations between the pinless array and the femoral bone were detected, the pinless array can be used to assess leg length and offset when used with a specific measurement technique that compensates for such variations. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:583–588, 2010     

Observations of health-care professionals sharing and contributing responsibility in paediatric caring situations

This study aimed to identify, describe and generate concepts regarding health care professionals' information exchanges with minors and/or their parents/guardians in paediatric caring situations. The study took place at three paediatric outpatient units at a university hospital and there were 15 health care professionals involved. Using the grounded theory and the constant comparative analysis methods, the data collection and analysis was undertaken simultaneously, using participant observation, review of medical records and follow-up interviews. The main concern of the health care professionals that emerged as the core category was: sharing and contributing responsibility, interrelated with the six categories; interchanging of knowledge, relationship-creating chat, calculated confirming, encouraging, dichotomous talking and of situation related effects. This research has explored the elements of information exchange in caring situations and highlighted the interaction between the involved persons. These findings could be valuable to health care professionals in order to develop and improve their caring skills.     

218例巨大胆总管结石病人临床诊疗分析

目的 探讨分析218例巨大胆总管结石病人的临床表现、辅助检查、内镜治疗及并发症发生情况.方法 将218例胆总管结石(直径≥2 cm)病人作为观察组,并按结石数量分为1枚结石组、2枚结石组和>2枚结石组;另取231例胆总管结石(直径<2 cm)病人作为对照组.分析各组的病史资料、临床表现、实验室检查、内镜下治疗情况及并发症发生情况.结果 观察组病人中,有胆系感染、胆总管切开取石病史的比例显著高于对照组(26.6%、15.6%与15.2%、7.8%).有急性胰腺炎病史的比例显著低于对照组(9.6%与16.9%).2枚结石组和>2枚结石组中腹痛、发热的发生率显著高于对照组(88%、94.2%与74.5%,64%、65.4%与41.6%),>2枚结石组中黄疸、腹泻的发生率显著高于对照组(78.8%与51.1%,44.2%与26.8%).2枚结石组和>2枚结石组中血总胆汁酸、碱性磷酸酶及γ-谷氨酰转酞酶水平均显著高于对照组,>2枚结石组血总胆红素及直接胆红素水平显著高于对照组.取石术后总胆红索、直接胆红素、总胆汁酸及碱性磷酸酶水平较术前显著降低.2枚结石组和>2枚结石组中内镜下取石的成功率及一次取石成功率均显著低于对照组(88%、79%与94%,72%、56%与82%),平均住院天数显著高于对照组(13±4.6、16±5.2与10±3.8).>2枚结石组在取石过程中发生结石嵌顿、乳头部出血及心律失常的比例显著高于对照组(21%、33%、15%与6.9%、19%、9%).2枚结石组和>2枚结石组取石后发生急性轻型胰腺炎的比例显著高于对照组(15%、23%与7.4%),>2枚结石组取石后出现高淀粉酶血症的比例显著高于对照组(17%与6%).结论 反复胆系感染、胆总管切开取石与胆总管巨大结石的发生密切相关,胆总管巨大结石病人更易出现黄疸、腹泻及胆汁淤积,且内镜取石的难度显著增加,术中及术后更易出现并发症.     

江西省致乏库蚊抗药性现状分析

目的：探讨我省不同地区致乏库蚊对化学杀虫剂的抗药性现状。方法：采用浸渍法测定致乏库蚊幼虫的ＬＣ５０。结果：不同地区致乏库蚊对溴氰菊酯均达到相当高的抗性水平；对敌敌畏和三氯杀虫酯的抗药性明显；对仲丁威的抗药性尚不明显。结论：抗二二三的江西蚊虫，对溴氰菊酯存在严重交互抗性。抗药性产生与本地用药史和使用频度直接相关。抗性治理：应针对性地采取轮用、混用杀虫剂，加增效剂和综合防制等多项措施，降低药剂对蚊虫的选择压力。     

儿科住院医师工作现状和流失情况分析与对策

目的 了解儿科住院医师的工作现状和流失情况,并探讨应对策略.方法 采用问卷调查和专家访谈法,选取上海交通大学医学院附属的三家儿科特色医院的120名儿科住院医师进行问卷调查,同时对6名相关管理人员进行访谈.结果 儿科住院医师对总体工作状况的满意度为28.85%.儿科住院医师流失的主要原因有工作辛苦、收入低、没有好的发展前景等.结论 儿科住院医师对工作现状的满意度不高,导致儿科住院医师工作效率降低及儿科专科人才流失等问题.国家应重视和发展儿科医学教育,为儿科医学发展培养和储备人才;加大对儿科乃至整个医疗事业的投入,减轻医院的经济负担,提高儿科住院医师的价值观,建立和谐的医疗环境.     

建立医院感染控制管理网 提高传染病的疫情管理

目的改革医院传统的传染病上报、疫情管理的模式,提高传染病的疫情管理质量。方法依托医院良好的一号工程信息化平台,建立医院感染控制管理网络,集传染病信息直报、查询、统计、监督预警、管理发布为一体。结果确保了传染病报卡的时效性;提高了传染病报卡准确性;便于及时、准确掌握疫情动态;更多的信息交流,更主动的参与;更紧密结合临床实际工作;提供了培训和宣传教育的良好平台。结论通过信息、网络化管理方式,实现了全员、全方位的管理,提高传染病疫情管理工作的质量和效率。     

1956—2008年蓬莱市法定传染病疾病谱分析

目的分析蓬莱市1956—2008年甲、乙类传染病的发病趋势,为制定传染病防控措施提供理论依据。方法采用描述性流行病学的方法对蓬莱市1956—2008年法定传染病疫情资料进行统计分析。结果1956—2008年,蓬莱市法定报告甲、乙类传染病发病率和死亡率均呈下降趋势,总体发病率最高为7521.35/10万(1957年),最低为103.48/10万(2007年),年平均发病率为671.29/10万。死亡率最高为55.81/10万(1958年),年平均死亡率为5.90/10万。各类传染病发病比例发生明显变化,50—60年代,以呼吸系统传染病为主,发病率居前5位的是流行性感冒、麻疹、百日咳、流行性脑脊髓膜炎和肝炎。90年代后,以肠道传染病为主。2000—2008年居前5位的传染病是病毒性肝炎、肺结核、痢疾、淋病和梅毒。结论蓬莱市在控制普通传染病的同时,应将工作重点放在肠道和呼吸道等传染病的防治上,并制定针对性的防治策略。同时也应加强血源及性传播传染病的防治和监测。     

玉树地震后灾民安置点卫生防疫工作现况

通过对玉树地震后安置点建筑格局以及道路规划、饮用水情况、厕所建造情况、生活垃圾和医疗垃圾的处理、消毒工作的开展情况进行调查,初步了解地震后安置点内卫生防疫工作状况,对其中的优势和不足进行探讨。     

异化处境中的生存之痛——解读毕飞宇长篇小说《平原》

从人的存在本质和处境关系上解读毕飞宇的长篇小说《平原》,可以看出由特定政治意识形态和乡村传统习俗文化所形成的存在处境对于人的存在异化。作品揭示了命运掌握在“他人”手中的悲剧性,反讽了生存处境的非理性和荒诞性,昭示对存在理性的深度呼唤。     

Vitamin A supplementation during war-emergency in Guinea-Bissau 1998-1999

BACKGROUND: Vitamin A supplementation is recommended by WHO in emergency situations. OBJECTIVE: To evaluate the impact of Vitamin A supplementation on childhood mortality in an emergency situation. DESIGN: Since this was not a randomised study, we evaluated the impact in different ways; we used the variation in the delay of provision of Vitamin A in a step-wedged design, compared wartime with pre-wartime mortality and examined whether Vitamin A as a free commodity reduced cultural and social-economic inequalities in childhood mortality. SUBJECTS: 5926 children 6 months to 5 years of age, resident in four suburbs in the capital of Guinea-Bissau between October 1, 1998 and March 31, 1999. INTERVENTIONS: From October 1, 1998 until the end of the war in 1999 all children present in the study area were offered Vitamin A at regular three-monthly visits to their homes. RESULTS: Using the variation in the provision of Vitamin A, we found a slight non-significant reduction in mortality for children between 6 months and 5 years of age (mortality ratio (MR) 0.49; 95% CI 0.09-2.70). Comparing with a three-year period before the war, children offered Vitamin A at home during the war had a 12% reduction in mortality (MR 0.88; 0.41-1.87), whereas the overall impact of the war was an 89% increase in mortality (MR 1.89; 1.32-2.71). Vitamin A supplementation was associated with a reduction in cultural and socio-economic inequalities. CONCLUSIONS: Vitamin A supplementation may have a beneficial impact on childhood mortality in an emergency situation.